Job Title: Care Manager & Provider Relations Administrator
Organization: IAA-Resolution Health East Africa Limited
Duty Station: Kampala, Uganda
About Us:
IAA-Resolution, which is a partnership between IAA Healthcare and Resolution Health East Africa, offers healthcare packages that provide our clients with high value in benefits and unique service. IAA- Resolution has a strong accredited medical service provider network of over 500 hospitals, clinics and doctors all across East Africa.
Job Summary:
The Care Manager & Provider Relations Administrator will be primarily interface with medical service providers and acquire the best service provision arrangements for our members.
Key Duties and Responsibilities:
1. Provider Relations:
-Undertake contracting of providers (hospitals and clinics)as per company protocols.
-Administer the company’s accounts at providers.
-Monitor and stock medical service providers with scheme documents and forms.
-Manage processes to do with members’ direct access to specialists.
-Conduct provider audits to ensure conformance with business requirements.
-Undertake claims reconciliation with service providers and negotiate discounts.
-Undertake provider training.
2. Care Management:
-Coordinate the integration of care management functions into patient care
-Undertake pre-authorization and care management for scheme members for service access within and outside Uganda;
-Manage hospitalizations as per RIL care management protocol.
-In liaison with the physician maintain an appropriate cost, case and desired patient outcome
-Evaluate patient satisfaction and quality of care provided
-Manage rescue and evacuations of members.
-Assist members with chronic diseases on best practice disease management as per the RIL disease management protocol.
-Maintain good relationships between providers and the company for the good of the scheme.
-Coordinate International Emergency and Planned Admissions.
-Undertake any third party recoveries as applicable.
-Maintain all client pre-authorization records and hospitalization case notes records and provide weekly, quarterly & annual reports regarding care and provider operations as required.
Qualifications, Skills and Experience:
-The applicant should possess a Diploma in Nursing or Clinical Medicine and / or Diploma or degree in a business field
-Comprehensive knowledge of care and health management
-Three years’ experience in care management in a large modern hospital
-Experience in a HMO/MIP an added advantage.
-Accounting knowledge an added advantage
-Knowledge of Microsoft Office with excellent skills in Excel
-Proficiency in driving with a valid driving License
-Good oral and written communication skills
-Exceptional commitment to customer service
-Good analytical and problem solving skills
-Organized, able to prioritize work
-Outstanding communication skills – both verbal and written
-Exceptional commitment to customer service
-Good analytical and problem solving skills
How to Apply:
If you believe you are a team player and would be a valuable resource to this ever growing brand, please:
Click here to register your application
Email your application to jobs@iaa-resolution.co.ug consisting of your application letter and updated CV listing three references, quoting the position in the email subject.
Only applications registered as per step 1 with a matching CV sent to us shall be considered.
Deadline: 7th November, 2013
Organization: IAA-Resolution Health East Africa Limited
Duty Station: Kampala, Uganda
About Us:
IAA-Resolution, which is a partnership between IAA Healthcare and Resolution Health East Africa, offers healthcare packages that provide our clients with high value in benefits and unique service. IAA- Resolution has a strong accredited medical service provider network of over 500 hospitals, clinics and doctors all across East Africa.
Job Summary:
The Care Manager & Provider Relations Administrator will be primarily interface with medical service providers and acquire the best service provision arrangements for our members.
Key Duties and Responsibilities:
1. Provider Relations:
-Undertake contracting of providers (hospitals and clinics)as per company protocols.
-Administer the company’s accounts at providers.
-Monitor and stock medical service providers with scheme documents and forms.
-Manage processes to do with members’ direct access to specialists.
-Conduct provider audits to ensure conformance with business requirements.
-Undertake claims reconciliation with service providers and negotiate discounts.
-Undertake provider training.
2. Care Management:
-Coordinate the integration of care management functions into patient care
-Undertake pre-authorization and care management for scheme members for service access within and outside Uganda;
-Manage hospitalizations as per RIL care management protocol.
-In liaison with the physician maintain an appropriate cost, case and desired patient outcome
-Evaluate patient satisfaction and quality of care provided
-Manage rescue and evacuations of members.
-Assist members with chronic diseases on best practice disease management as per the RIL disease management protocol.
-Maintain good relationships between providers and the company for the good of the scheme.
-Coordinate International Emergency and Planned Admissions.
-Undertake any third party recoveries as applicable.
-Maintain all client pre-authorization records and hospitalization case notes records and provide weekly, quarterly & annual reports regarding care and provider operations as required.
Qualifications, Skills and Experience:
-The applicant should possess a Diploma in Nursing or Clinical Medicine and / or Diploma or degree in a business field
-Comprehensive knowledge of care and health management
-Three years’ experience in care management in a large modern hospital
-Experience in a HMO/MIP an added advantage.
-Accounting knowledge an added advantage
-Knowledge of Microsoft Office with excellent skills in Excel
-Proficiency in driving with a valid driving License
-Good oral and written communication skills
-Exceptional commitment to customer service
-Good analytical and problem solving skills
-Organized, able to prioritize work
-Outstanding communication skills – both verbal and written
-Exceptional commitment to customer service
-Good analytical and problem solving skills
How to Apply:
If you believe you are a team player and would be a valuable resource to this ever growing brand, please:
Click here to register your application
Email your application to jobs@iaa-resolution.co.ug consisting of your application letter and updated CV listing three references, quoting the position in the email subject.
Only applications registered as per step 1 with a matching CV sent to us shall be considered.
Deadline: 7th November, 2013